Cardiac Rehabilitation Availability and Delivery in Canada

How Does It Compare With Other High-Income Countries?

Michelle Tran, Ella Pesah, Karam Turk-Adawi, Marta Supervia, Francisco Lopez-Jimenez, Paul Oh, Carolyn Baer, Sherry L. Grace

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). Methods: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada's Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. Results: CR was available in 10 of 13 (76.9%) provinces (no programs in Canada's North), with 74 of 182 programs initiating a survey (40.7% response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90% of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). Conclusions: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.

Original languageEnglish (US)
Pages (from-to)S252-S262
JournalCanadian Journal of Cardiology
Volume34
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Canada
Myocardial Ischemia
Guidelines
Multilevel Analysis
Cardiac Volume
Return to Work
Cardiac Rehabilitation
Ontario
Health Expenditures
Chronic Disease
Cross-Sectional Studies
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac Rehabilitation Availability and Delivery in Canada : How Does It Compare With Other High-Income Countries? / Tran, Michelle; Pesah, Ella; Turk-Adawi, Karam; Supervia, Marta; Lopez-Jimenez, Francisco; Oh, Paul; Baer, Carolyn; Grace, Sherry L.

In: Canadian Journal of Cardiology, Vol. 34, No. 10, 01.10.2018, p. S252-S262.

Research output: Contribution to journalArticle

Tran, Michelle ; Pesah, Ella ; Turk-Adawi, Karam ; Supervia, Marta ; Lopez-Jimenez, Francisco ; Oh, Paul ; Baer, Carolyn ; Grace, Sherry L. / Cardiac Rehabilitation Availability and Delivery in Canada : How Does It Compare With Other High-Income Countries?. In: Canadian Journal of Cardiology. 2018 ; Vol. 34, No. 10. pp. S252-S262.
@article{c8e4511c6c524c01801f0258cf2952cd,
title = "Cardiac Rehabilitation Availability and Delivery in Canada: How Does It Compare With Other High-Income Countries?",
abstract = "Background: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). Methods: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada's Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. Results: CR was available in 10 of 13 (76.9{\%}) provinces (no programs in Canada's North), with 74 of 182 programs initiating a survey (40.7{\%} response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7{\%}), but in 23 (31.5{\%}), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90{\%} of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). Conclusions: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.",
author = "Michelle Tran and Ella Pesah and Karam Turk-Adawi and Marta Supervia and Francisco Lopez-Jimenez and Paul Oh and Carolyn Baer and Grace, {Sherry L.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1016/j.cjca.2018.07.413",
language = "English (US)",
volume = "34",
pages = "S252--S262",
journal = "Canadian Journal of Cardiology",
issn = "0828-282X",
publisher = "Pulsus Group Inc.",
number = "10",

}

TY - JOUR

T1 - Cardiac Rehabilitation Availability and Delivery in Canada

T2 - How Does It Compare With Other High-Income Countries?

AU - Tran, Michelle

AU - Pesah, Ella

AU - Turk-Adawi, Karam

AU - Supervia, Marta

AU - Lopez-Jimenez, Francisco

AU - Oh, Paul

AU - Baer, Carolyn

AU - Grace, Sherry L.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). Methods: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada's Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. Results: CR was available in 10 of 13 (76.9%) provinces (no programs in Canada's North), with 74 of 182 programs initiating a survey (40.7% response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90% of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). Conclusions: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.

AB - Background: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). Methods: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada's Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. Results: CR was available in 10 of 13 (76.9%) provinces (no programs in Canada's North), with 74 of 182 programs initiating a survey (40.7% response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90% of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). Conclusions: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.

UR - http://www.scopus.com/inward/record.url?scp=85054084658&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054084658&partnerID=8YFLogxK

U2 - 10.1016/j.cjca.2018.07.413

DO - 10.1016/j.cjca.2018.07.413

M3 - Article

VL - 34

SP - S252-S262

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

SN - 0828-282X

IS - 10

ER -